Mark’s Daily Apple

Dear Mark: Mulling Multivitamins21

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Choices, choices.

Dear Mark,

I’m new to your blog and am interested in taking better care of my health. I’m changing my diet and want to start a multivitamin. I go to the store though and end up bewildered enough that I don’t end up buying anything. What am I supposed to be looking for?

Not surprisingly, I get a good number of questions about supplements. Since it’s a topic I’m obviously passionate about, I’m always happy to offer advice on what my research and experience have taught me about wise supplementation.

First off, I definitely recommend the kind of product you’re looking for: a core nutrient assurance. As you know, I’m all about a good diet – a great diet, in fact. But a great diet with strategic supplementation can offer optimum health benefits A few fundamental suggestions:

• The divide from one “multivitamin� to another can be, well, cavernous. Unfortunately, there’s a lot of junk out there – incomplete, impure, inconsistent “formulas� (if you can truly call them something as intentional as formulas at all). Select a multivitamin from a trusted source to ensure you’re getting a product that offers purity as well as accurate and consistent dosages of nutrients. Yes, you’d think this would be a given, but it’s not. Many products, when tested by consumer advocacy groups, have been shown to not even contain some of their advertised nutrient ingredients or to contain certain ingredients at toxic levels. Some have even been shown to contain lead, presumably from subpar manufacturing conditions.

• I think a “multivitamin� should be more than a collection of a few vitamins. And most people really do want more than that. For the best benefit, look for a comprehensive daily nutrient supplement that offers the full array and appropriate balances of vitamins, minerals, phytonutrients and beneficial plant extracts. I never recommend supplementing piecemeal: a B-6, a calcium
chew, a vitamin C tablet, etc. Not only is this approach incomplete; you risk lack of absorption or redundancy of nutrients. More about that in a minute.

• For maximum potency, consider the freshness of vitamins. Many people would be surprised to know that store bought vitamins can sit on shelves for months or even years before being purchased. (And that doesn’t include the time they sat in warehouses and in multiple transports!) Liquid vitamin formulas, in particular, lose potency relatively quickly and oxidize easily. I would advise against them.

• Speaking of multivitamin “form,� tablets or caplets can be problematic as well. Because uncoated tablets don’t offer any buffer, they can irritate the stomach. On the other hand, caplets can have such a hard coating that they don’t fully dissolve and can become, as nurses call them, “bedpan bullets.� (There’s an image for your day.) On top of that, vitamins in caplet or capsule form can have unnecessary gums, glue, fillers and binders. The key is to find a formula that balances ease of absorption and natural buffering. Capsules with only essential ingredients are best. And I highly recommend a formula that contains enzymes for optimum absorption.

• The mark of a quality formula is the bioavailability and appropriate balance of its nutrient contents. I could talk forever and a day about this subject, but let me just give a few examples of what I mean. A quality formula contains the more “bioavailable� form of vitamin D, which is D3. Cheaper, lower quality supplements contain D2, which also happens to be the form used to enrich milk. A quality formula contains vitamin B12 as methylcobalamin and not cyanocobalamin. It should contain vitamin B6 as pyridoxal 5’ phosphate, the metabolically active form, and not pyridoxine.

• Likewise, the ability of the body to best absorb most nutrients involves those nutrients’ synergistic relationships, so to speak. Take beta carotene. There are over 500 carotenes, and optimum absorption and utilization occurs when they’re taken together. A hallmark of a quality formula: mixed carotenoids. Other examples include spectrum vitamins like B and E (with alpha, beta, delta and gamma tocopherols). Taking only one form of either doesn’t make any sense and won’t do you much good. You might as well throw your money down the toilet. Look for both mixed tocopherols and tocotrienols, the two main groups in the vitamin E complex.

• Finally, there are the basics. It’s important to expect the best in terms of protection. Make sure the bottle is in a protective sleeve. In most cases, multivitamins are only protected by the bottle cap. Also, look for added layers of protection from air and light to ensure freshness and full potency.

If you’re interested in learning more about the benefits and ideal formulations of particular nutrients, I recommend checking out these non-profit scientific research sites. (And, as always, share your choice with your doctor.)

• PLoS Public Library of Science
• Vitasearch
• PubMed

Thanks to all who have sent questions. Please keep ‘em coming!

nats Flickr Photo (CC)

Further Reading:

The ORAC Gift of Health

Debunking Vitamin Myths

Posted: Dear Mark, Health, How To, Men's Health, Nutrition, Personal Improvement, Supplements, Women's Health

Study Finds Frequent Sleep Disruption Increases Risk of Kidney, Heart Disease11

Something else to lose sleep over…

A study published in the April edition of the American Journal of Physiology - Regulatory, Integrative and Comparative Physiology suggests that frequent disruptions in the sleep cycle (also known as circadian rhythm) can increase the risk of kidney and heart disease. (The study is not yet available online.)

Conducted by researchers from the Peter Munk Cardiac Centre at Toronto General Hospital, the study altered the internal biological clocks of rodent (hamster) models using external regulators (such as reversing light and dark periods) and found that the changes resulted in cardiomyopathy (damage and enlargement of the heart) and scarring of the kidney tubules.

Based on findings from this and several other previous studies, the researchers concluded that renewal of organ tissues likely occurs during sleep, suggesting that sleep disruption prevents this process from happening and results in damage to the organs.

The researchers note that these problems may be particularly acute among flight crews, truck drivers, and “graveyard� or other variable shift workers. In fact, while most studies of these populations have focused on the effects of sleep deprivation and concentration and performance, the latest study may help explain why such workers have higher rates of cardiovascular disease. With that being said, the study’s lead author suggests that such workers consider these findings when scheduling work time,� or at the very least “try to maintain a constant working schedule for one month or more [to allow] the body to readjust its clock to external cues.�

Don’t have an erratic work schedule? Unfortunately that doesn’t mean that you’re immune to sleep disruptions. A new baby (or just one that’s acting possessed as of late!), a stressful work project, or even just a few late nights in a row can throw your sleep schedule into a rut.

But, if there’s one tried and true tip for regulating your sleep pattern, its eschewing those weekend lie ins. Yes, it feels great to sleep ‘till noon, especially if you’ve had a rough week, but setting your alarm for just one hour beyond your usual wake up time will allow you to feel well rested without sending your body in to shock once Monday morning rolls around!

joshunter Flickr Photo (CC)

Further Reading:

Americans Get Too Little Sleep

7 Tips to Get Out of Bed

Posted: Health, Men's Health, Prevention, Women's Health, Worker Bees' Weekly Bites

The Salt/Blood Pressure Debate12

Rain, rain, go away…

In response to last week’s canned soup post, reader Dave offered this comment: “I’d just like to point out that just as many Apple readers believe in literature that debunks the lipid hypothesis, there’s a camp that says there is minimal effect on blood pressure from salt. There are two sides to many stories!â€�

We couldn’t agree more that nutritional (or general health) debates are rarely so simple as they’re made out to be. As long-time readers have probably noticed, we’ll mention salt recommendations now and then and generally try to keep our recipe suggestions fairly low in salt. We do tend to follow general salt recommendations. Blood pressure issue aside, high salt intake (as we mentioned last week) has been associated with osteoporosis, asthma, kidney disease and stomach cancer.

But what about the salt and blood pressure issue? Does it really hold water (pun intended)? We’d say it has enough bearing to figure into our choices, and for some people, research suggests, it’s crucially significant.

For years, scientists have researched the possibility of a “salt sensitive hypertension� that was the general result of a person’s genetic profile. In other words, salt sensitive peoples’ blood pressure is impacted more than the average person’s. To be precise, their blood pressure rises 10% or more in response to a salty meal.

In 2006, researchers at the University of Virginia Health Center announced that they had traced the “sensitive� salt response to particular gene variations and that they were in the process of completing a genetic test for the salt sensitive profile. Salt sensitivity, researchers say, whether it accompanies chronic high blood pressure, negatively impacts the vascular system in the same way high blood pressure itself does. African-Americans are more likely to be salt-sensitive than people of other races in the U.S. The test, once it becomes readily available, will hopefully be a useful tool for people who want to learn more about steps essential for their individual health.

But as for the rest of us, does salt matter for blood pressure? It’s true that many studies in this area, as in all areas, have their failings. And, it’s true that salt is just one piece (albeit an important one) involved in the process of fluid retention and its link to higher blood pressure.

Yet, there seems to be enough suggestion that salt can have a significant or at least measurable impact on blood pressure. A unique look into the connection was found in a recent study that compared blood pressure in groupings of salt mine workers in India, dividing those who worked directly with the processing of salt and those that worked away from the milling plant and its processing steps. The group that worked directly with the salt and had opportunity for inhalation of salt on a daily basis showed higher blood pressure (average of 4 points higher for the systolic measurement) than the group that didn’t work in the mill. After a group of mill workers used face masks and goggles for just four days, their blood pressure dropped an average of ten points in the systolic measurement.

While the above study examines a mode of salt intake other than ingestion, there is no shortage of studies that measure the effects of reducing dietary salt intake. Follow up research on two study groups from the 1990s help strengthen the argument for lower salt intake as helpful in preventing heart disease. Former subjects that had been part of the intake “intervention� group and were given the low salt diet, 10-15 years later had a “25% reduction in the risk of cardiovascular disease.�

Another study out in 2006 showed significant and positive impact of salt substitute use in Northern rural China, which is known to have especially high rates of hypertension as well as high salt intake. The salt substitute, researchers said, “demonstrated that it could reduce blood pressure to about the same extent as single drug therapy.”

And, ultimately, what does a low salt diet look like? First off, it should mean pretty much no processed food. We definitely support that! Up to ¾ of American’s salt intake comes from processed foods – those curious boxed creations you find in the middle of the grocery store, cured meats, etc. Cut those out, and you’re already in good shape. We certainly don’t begrudge anyone reaching for the salt shaker. We do, but we also don’t rely on it for taste. The more people moderate (yes, moderation is the key here, not elimination) their salt intake, the more likely they are to turn to other sources of flavorings, hopefully healthful ones like herbs and more varied, flavorful ingredients like peppers, onions and other vegetables and fruits. At least, that’s what we’d suggest.

This is one of those fascinating discussions that we love to continue. We’re always on the lookout for research from both sides of the issue. Keep your comments coming!

Further Reading:

10 Ways to Reduce Salt

10 Innovative Uses for Salt

Sugar Shock - Salt: The “Forgotten Killer”

The Migraineur: Salt No Longer Generally Recognized As Safe?

Posted: Diet, Health, Men's Health, Prevention, Women's Health

Yoga Good for Beating Symptoms of Breast Cancer4

Do some yoga, and you too can look this good in white spandex.

A study presented Saturday at the International Association of Yoga Therapists Symposium for Yoga Therapy Research in Los Angeles suggests that yoga may ease menopause symptoms in breast cancer survivors.

Breast cancer survivors suffer more severe menopause symptoms than other women, largely because the drugs used to prevent cancer recurrence can exacerbate the symptoms of menopause (hello hot flashes!) Furthermore, women with breast cancer are very much limited in their treatment options for menopause symptoms because traditional aides, such as hormone replacement therapy, may increase their risk of future recurrence.

For the study, a team of researchers from Duke University Medical Center evaluated the self-reported menopause symptoms of 37 women with early stage breast cancer enrolled in an eight week “Yoga of Awareness� program. Although based on traditional yoga techniques and poses, the Yoga of Awareness program was designed specifically to reduce stress and create a heightened sense of the body’s wellbeing.

Compared to a control group with no intervention, women in the yoga group experienced significant reductions in the frequency and severity of menopause symptoms, including hot flashes, fatigue, joint pain, sleep disturbance and symptom-related distress. This trend continued even three months after the yoga program had ended.

These findings dovetail nicely with a 2006 study conducted by University of Texas, M.D. Anderson Cancer Center researchers that found that “even a short yoga program - including meditation, relaxation, breathing exercises, stretching, imagery and physical movements - can be very useful at reducing the side effects that come with breast cancer treatment,� including fatigue and daytime sleepiness.

Researchers in the first study recommend that “women seeking similar results could consult with an experienced yoga instructor to learn some of the same techniques� and suggest that patients work with instructors to identify a routine that will maximize symptom relief.

With almost no exceptions, yoga is the one exercise that just about everyone can do. It doesn’t require any equipment (although a mat certainly makes things more pleasant!), can be done at any time of the day and in any location (office yoga anyone?), and can be tailored to suit the needs/physical limitations of its students. Plus, when evidence such as this suggests that its health benefits may extend beyond the aesthetic, it makes the idea of giving it a shot that much more appealing. Now granted, we’re not suggesting that you pack in your conventional training routine for everyday yoga sessions, but incorporating at least some of the moves certainly won’t do you any harm and, as a side benefit, may actually boost your performance in other exercise areas (because after all, flexibility, stamina, and control are integral to just about every physical activity we do!)

myyogaonline Flickr Photo (CC)

Further Reading:

The Biggest Myth About Cancer: That it Just “Happens”

BBC: Nanomagnets ‘could target cancer’

Technorati Tags: cancer, yoga, menopause, hot flash

Posted: Fitness, Health, Prevention, Women's Health, Worker Bees' Weekly Bites

More Chronic Cardio Talk26

This guy can’t be stopped!

A few weeks back my Chronic Cardio post got a lot of response and initiated some great discussion. Since it’s one of the cornerstones of the Primal Blueprint philosophy (and an obviously popular one at that), I thought it was worth more time and tender loving attention.

And why wouldn’t anyone want to hear that real exercise doesn’t mean endless hours on that torturously boring treadmill? News like this is like sunlight bursting in, choirs of children singing, shackles collapsing open and crashing to the ground. Hordes of celebratory folk parade through the gym, penny whistles and fiddles playing, ale mugs in hand, goats and cows in the merry mix. Get off that treadmill and join us, for the love!

Truly, how many people give you great news like this on a random Tuesday– permission to leave the life of chronic cardio for the promise of less time, more muscle, better health? Of course, I’m certainly not advocating giving up all training – just that certain problematic, unnecessary type. I’d encourage you to reread all of the discussion and great comments offered up. Here’s a sampling of my contribution to that post conversation.

It all comes down to this: fat loss depends 80% on what and how you eat. Retrain your energy systems to burn fat and not glucose. Cutting out all simple carbs is the key. It’s about insulin management. If you can readjust the diet to encourage the body to burn fats, you won’t need to replenish lost glycogen every day. You’ll always burn fats and you’ll always have energy. The low level aerobic stuff becomes “filler”…so you only do it if it’s fun, like a hike or walk with friends or golf or mountain biking. The real muscle growth will come from the short anaerobic bursts like sprints, intervals or weight-training. I’ll do a piece on this later, but check out my friends at http://www.crossfit.com . They get more done in 20-30 minutes than most of the gym rats doing 90 minute weight sessions. And because it’s a “circuit training” concept, they get plenty of heart-training (cardio) as well. And growth hormone release and insulin sensitivity, and….you get the point.

In our cardio addicted culture, it can sound too good – too simple – to be true. But the science and the research is there, folks. Short “interval� exercise, like sprints or strength training, can offer the same fitness benefits (and then some) compared with traditional endurance training. Take this study via Science Daily via McMaster University. In the context of six training sessions during a two week study period, half of the college aged subjects did 90-120 minutes per session of a continuous moderate-intensity cycling routine while the other half did between four and six 30-second intensive cycling bursts. At the end of the two week study period, the endurance cycling subjects had each invested 10.5 hours. The intensive interval subjects had invested just 2.5 hours. Yet, the improvements in fitness performance and muscle parameters were the same.

Interested in hearing more?

A study (PDF) from the University of New South Wales followed the fitness and body composition changes in 45 overweight women in a 15-week period. The women were divided into two groups and assigned interval or continuous cycling routines. The interval “sprint� cycling group performed twenty minutes of exercise, which repeated eight seconds of “all out� cycling and then twelve seconds of light exercise. The continuous group exercised for 40 minutes at a consistent rate. At the end of the study, the women in the interval group had lost three times the body fat as the women in the continuous exercise group. (An interesting note: the interval group’s loss in body fat came mostly from the legs and buttocks area.)

The study’s organizers, in their presentations to the Heart Foundation and American College of Sports Medicine, discussed the role of sprinting in metabolic response. Intense interval training, they said, results in higher levels of catecholamines, a compound related to fat oxidation.

More yet?

Another collaborative study organized by universities and health institutes in Denmark and Japan highlighted the same distinction in fat oxidation between prolonged, continuous exercise and shorter, intense interval routines. In addition to additional fat oxidation, the study’s results linked interval exercise with lower plasma glucose, increased epinephrine response, lower insulin concentration and increased fat oxidation during the recovery period.

Don’t you just love this stuff?? Folks, this is ground breaking stuff. Now I just scratch my head at why we keep running ourselves ragged? The message is out there, but it’s not reaching people.

We’d love to hear your experiences with interval training as well as your questions/impressions of this less prescribed (but highly effective) approach. Thanks for reading!

Abraaj, Kazze, Rosh PR, Atari, Gracinha & Marco Flickr Photos (CC)

Further Reading:

A Case Against Cardio

CrossFit: Your New Workout Routine

Interactive Health: High Intensity Interval Training

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Technorati Tags: interval training, anaerobic, aerobic, chronic cardio, Primal Blueprint, CrossFit

Posted: Fitness, Health, Men's Health, Personal Improvement, Primal Health, Sisson Said What?, Weight loss, Women's Health